Government fails to collect $226 million in Medicaid overpayments

A surgical clamp holding money.The government is falling short in its job to collect hundreds of millions of dollars in Medicaid overpayments, according to a report released this month by the Department of Health and Human Services’ Office of the Inspector General.

The job of collections falls to the Centers for Medicare and Medicaid Services and according to the report there’s about $226 million in Medicaid overpayments that have gone to 11 states.

As of December 2012, CMS reported collecting $987,481,600 of the $1,213,085,167 in overpayments issued between fiscal years 2000 and 2009, according to the report. “However, CMS had not collected the remaining $225,603,567 because it had not always proceeded with the collection process in a timely manner,” the report notes.

OIG made the following recommendations:

  • Collect the remaining $225,603,567 that is due the federal government.
  • Review and address delays in resolving OIG audit recommendations and promptly pursue corrective actions.
  • Maintain adequate documentation to support the collection of overpayments in accordance with OMB Circular A-50 and CMS standard operating procedures.
  • Educate the states about their responsibility to report overpayments on the correct line of the CMS-64 to improve oversight of the reporting process.

In its response, CMS said it failed to collect some overpayments because additional review of the claims was needed, according to the report.

States affected are: Indiana, Illinois, Kansas, Louisiana, Missouri, New Jersey, Oregon and Pennsylvania. CMS is working to collect overpayments to Medicaid providers in Florida, New York and Massachusetts.

Click here to read the entire report.

Implementation of Physician Payments Sunshine Act delayed until 2013

May 7, 2012 – The federal government is putting off, until 2013, a key provision of the country’s healthcare overhaul that’s designed to shed light on the financial relationships between doctors, pharmaceutical companies and medical device makers.

The Centers for Medicare and Medicaid (CMS) recently announced that it needs more time to implement the provision in order to give those reporting organizations time to prepare, and for the agency to read through the more than 300 public comments it received.

In a blog post, CMS said delay of the provision, which was included as section 6002 in the Affordable Care Act of 2010, will give it time to address operational and implementation issues in a thoughtful manner and to ensure the accuracy of the data that is collected.

The act requires companies to record physician payments worth more than $10 in 2012 and to report them on March 31, 2013. Payments include: stock options, research grants, consulting fees and travel to medical conferences. Details of these offerings will be posted on the web starting Sept. 30, 2013.

One of the sponsors of the act, Sen. Chuck Grassley of Iowa, said it was imperative that consumers know more about the financial relationships between their doctors and drug companies.

Pew Health Group reported that direct marketing by the pharmaceutical industry to medical professionals is estimated at $20 billion to $57 billion a year.

CMS said it plans to release the final rule later this year.


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